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Depression, Anxiety and Your Thyroid

Mental health issues are associated with thyroid problems in three key ways. First, people with thyroid disease have higher rates of mental health problems and symptoms. Second, some mental health symptoms are actually the symptoms of an undiagnosed or poorly treated thyroid condition and may resolve fully or in part with proper thyroid treatment. Third, there is evidence that some mental health conditions can be better treated by combining thyroid drugs with traditional antidepressant or antianxiety medications.

There is also a rare form of significant mental illness called myxedema psychosis, or colloquially, “myxedema madness,” caused by severe long-term hypothyroidism. Myxedema madness can be accompanied by extreme agitation, paranoia, psychosis, delusions, hallucinations, aggressiveness, and dementia. Myxedema madness usually resolves over time with aggressive thyroid hormone replacement therapy.

The relationship between thyroid disease and mental health issues is well-known and undisputed. Still, researchers do not have a clear and thorough understanding of why thyroid patients have an increased incidence of these mental health issues.

Depression

Depression (also known as major depressive disorder) is a condition that affects mood, thinking, and can cause physical symptoms. The symptoms range from mild to severe, and include:

Feelings of sadness

Feelings of emptiness

Difficulty concentrating, memory problems

Feeling overwhelmed

Difficulty sleeping or sleeping too much

Loss of interest in activities or hobbies

Low sex drive or loss of interest in sex

Overeating or a loss of appetite

Body and muscle aches and pains

Chronic headaches

Stomach and digestive problems

Thoughts of suicide

Depression is the most common mental health issue facing thyroid patients and is considered a symptom of both hypothyroidism and hyperthyroidism. Depression is actually so common in people with thyroid conditions that the prescribing instructions for all antidepressants recommend that your physician evaluates your thyroid function to rule out any thyroid abnormality before prescribing antidepressant drugs. The American Association of Clinical Endocrinologists supports this approach, saying: "The diagnosis of subclinical or clinical hypothyroidism must be considered in every patient with depression.” Unfortunately, thyroid screening prior to prescribing antidepressant drugs is rarely done by most general practitioners and primary care physicians.

At the same time, since the 1960s, a number of studies have demonstrated that the addition of thyroid hormone appears to accelerate and enhance the clinical response to antidepressant drugs. As a result, some psychiatrists prescribe thyroid hormone replacement medication — in some cases levothyroxine, and more commonly the synthetic T3 thyroid drug liothyronine (Cytomel) — along with traditional antidepressant drug therapy for refractory depression.

The diagnostic and treatment challenge for some patients and practitioners is in determining if the symptoms are evidence of depression or hypothyroidism — or both conditions. Harvard’s Health Letter outlined the shared symptoms, and the symptoms unique to depression, and to hypothyroidism:

Anxiety/panic disorders

Anxiety disorder, also known as generalized anxiety disorder (GAD) is a condition where you experience ongoing and longer-term anxiety or worry. The symptoms of anxiety disorder include:

Chronic worrying

Difficulty concentrating

Feeling jumpy and irritable

Pounding and rapid heartbeat, heart palpitations

Sweating

Stomach pain or nausea

Shortness of breath

Muscle tension, spasms, or twitches

Tremors, shaking, trembling

Insomnia

Panic disorder is a type of anxiety disorder that includes repeated periods of intense anxiety, as well as feelings of dread, fear, and doom accompanied by intense physical symptoms of anxiety.

Anxiety and panic disorders and symptoms are seen in both hypothyroidism and hyperthyroidism. In one research study of women psychiatric patients with a lifetime history of panic disorder:

27 percent had a history of thyroid disorder

17 percent had hypothyroidism

8 percent had hyperthyroidism

According to research, anxiety disorders have been found to occur in approximately 60 percent of hyperthyroid patients.

Again, proper thyroid diagnosis and treatment will, in some cases, improve or even fully resolve anxiety and panic symptoms.

What should you do?

If you are experiencing depression and considering antidepressant therapy, or have depression that is not responding to drug treatment, it’s important to have a thorough evaluation — including a clinical thyroid examination, and thyroid stimulating hormone (TSH), free T4, free T3, and thyroid antibody tests — to rule out an underlying thyroid problem. Similarly, if you are experiencing anxiety or panic disorder, you should have a clinical examination and a full panel of thyroid tests to rule out an underlying thyroid problem.

If your doctor discovers that you do have a thyroid condition, optimal thyroid treatment may resolve your mental health issues partially or fully without medication. Or, if you are already being treated with an antidepressant or anti-anxiety medication, optimal thyroid treatment may make it possible for your doctor to reduce your dosage of — or even eliminate — your medication.

Mary Shomon

Mary Shomon is a patient advocate and New York Times bestselling author who empowers readers with information on thyroid and autoimmune disease, diabetes, weight loss and hormonal health from an integrative perspective. Mary has been a leading force advocating for more effective, patient-centered hormonal healthcare. Mary also co-stars in PBS’ Healthy Hormones TV series.